1. Field of the Invention
This invention relates broadly to surgical devices. More particularly, this invention relates to a surgical device which provides a valved port in an anatomical passageway.
2. State of the Art
A vaginal hysterectomy is a hysterectomy performed through the anatomical passageway of the vagina without necessitating an abdominal incision. During the procedure, blood vessels nourishing the uterus and the ligaments supporting the uterus are tied off at the various points with sutures. The uterus is then surgically removed via the vagina. Methods for uterine removal are discussed in U.S. Pat. No. 5,520,698 to Koh which provides a complex apparatus for the disclosed methods. The Koh device generally includes an occluder provided with an opening, and a vaginal extender and uterine manipulator extending through the opening. The extender and manipulator are provided in the vagina where they provide anatomical landmarks to aid in colpotomy incision and uterine manipulation. Surgical instruments are then inserted laparoscopically through an abdominal incision into an insufflated abdominal cavity and using the extender and manipulator as guides and colpotomy incision backstops, and excise the uterus. However, the device includes several drawbacks which limits its use. First, if the extender and manipulator are removed from the occluder, the opening becomes a fluid passage. As such, the device cannot be used to retain an insufflation gas in the abdominal cavity after a hysterectomy unless the extender and manipulator remain within the opening, which obstructs the passage of other instruments therethrough. Second, when using the occluder in an insufflated environment, an obtrusive external handle is required to hold the occluder in place and counter pressure which would otherwise force the occluder out of the vaginal passageway.
After the removal of the uterus, it would be beneficial to view the ovaries and it may be deemed beneficial to perform an oophorectomy to eliminate the potential for subsequent ovarian pathology. Removing the ovaries reduces the risk of ovarian cancer, which is difficult to detect and often fatal. However, in a large percentage of vaginal hysterectomies, the ovaries are left in the body due to the difficulty in visualizing and excising the ovaries due to the location of the ovaries. In particular, after the removal of the uterus, in a non-insufflated environment, the abdominal cavity collapses into the space formerly occupied by the uterus, concealing the ovaries from view and surgical instruments used by the surgeon. While retractors and graspers can be used to reveal the ovaries to the surgeon, problems still remain in removing them due to their location.
Currently, it is difficult to insufflate the abdominal cavity proximate to the ovaries to increase laparoscopic visibility and instrument maneuvering, as the vagina provides an anatomical opening which would permit any insufflation fluid to escape. While, the Koh device does provide a vaginal seal when used for its particular purpose, it must be held in place, and the opening in the occluder is not adapted to permit the exchange of instruments during a procedure as insufflation gas would escape through the opening during the exchange.